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Many clinicians believe the second stage of labor (onset of full cervical dilation to delivery) is best managed with delayed pushing (also known as laboring down, passive descent, or rest and descend). To assess the effects of immediate versus delayed pushing on likelihood of vaginal delivery, 2414 women with term labor and neuraxial anesthesia were randomized to immediate initiation of pushing or a 1-hour delay in pushing.
Rates of spontaneous vaginal delivery were similar in the immediate and delayed pushing groups (85.9% and 86.5%, respectively). Duration of the second stage was shorter in the immediate group than in the delayed group (mean, 102 vs. 134 minutes). Incidence of maternal infection (chorioamnionitis) was lower in the immediat…